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Biomedical subjects

J V Banta

Publications and source records attributed to J V Banta.

At least 19 recordsLinked to original sources
PubMed2001

Scoliosis in cerebral palsy: an overview and recent results.

The natural history of scoliosis in cerebral palsy as well as the treatments that include observation, bracing, and surgery are reviewed. If surgery is indicated, a careful preoperative evaluation is essential, focusing especially on the patient's nutritional, gastrointestinal, neurologic, and orthopedic systems. Intraoperative and perioperative issues such as blood loss control are reviewed. The Luque-Galveston method of instrumentation for scoliosis secondary to cerebral palsy is our preferred method of treatment. Our recent results compare favorably with the literature with fewer complications.

Blood Loss, Surgical↗
PubMed2001

The evolution of gait analysis: a treatment decision-making tool.

The development of analytical techniques to define the abnormalities contributing to pathological gait patterns in human locomotion is complex. From the earliest attempts to draw static figures of the human form, physicians and scientists have devised unique paradigms to analyze various body segments in motion. The earliest studies were founded upon the discoveries of anatomy and physiology in the Renaissance. All subsequent advances have developed on that foundation. The discoveries of photography, electromyography, and the computer have led to today's advanced technology. Abnormalities of human locomotion can now be defined with accuracy in three dimensions and sufficient speed to be viable in a clinical setting. The objective documentation of gait through clinical gait analysis has not only gained for the physician a better understanding of the pathomechanics of gait abnormalities; it has become a valuable tool in treatment decision-making and evaluation. In treatment decision-making, gait analysis is used routinely to determine specific surgical procedures in patients of all ages with neuromuscular and other disorders. In treatment evaluation, gait analysis is becoming more relevant with the recent emphasis on outcome measures as a justification for insurance coverage.

Adult↗
PubMed2000

Effectiveness of the boston brace in treatment of large curves in adolescent idiopathic scoliosis.

STUDY DESIGN: This is a retrospective study of 50 patients with adolescent idiopathic scoliosis with curves measuring 35 degrees to 45 degrees who were treated with a Boston brace. OBJECTIVES: The purpose of this study was to determine whether the Boston brace could effectively halt long-term progression in skeletally immature adolescents with idiopathic scoliosis who had a curve between 35 degrees and 45 degrees. SUMMARY OF BACKGROUND DATA: The Boston brace has been shown to be effective in preventing curve progression in adolescent idiopathic scoliosis, but its efficacy in large curves has not been fully studied. METHODS: Fifty adolescents were treated with a Boston brace for idiopathic scoliosis curves of 35-45 degrees (mean, 38.55 degrees ). All were judged to be skeletally immature based on menarcheal status (mean, 2.6 months before menarche), Risser sign (mean, 0.90; range, 0-2), and chronologic age (mean, 13 +/- 1 years). Patients were recalled for long-term follow-up at a mean of 9.7 years (range, 6.23-13.22 years) after brace discontinuation. Three well-matched patient subsets were then identified based on compliance. Group 1 (n = 24) consisted of patients who were compliant with the brace program and wore the brace 18 or more hours per day, Group 2 (n = 14) contained patients who wore the brace 12-18 hours per day, and Group 3 (n = 12) contained patients who wore the brace 0-12 hours per day. RESULTS: There was a significant difference in the amount of initial correction seen in the brace between the groups: 49%, 45%, and 33% curve correction in the brace for Groups 1, 2, and 3, respectively (P < 0.05). At long-term follow-up there was a statistically significant difference between Groups 1, 2, and 3 in the percentage of patients in whom the curve had progressed to more than 45 degrees (P < 0.001), who had more than 5 degrees of curve progression (P < 0. 05), or who had undergone posterior spinal fusion (P < 0.001). CONCLUSIONS: These long-term data confirm that the Boston brace when used 18 or more hours per day is effective in preventing progression of large curves at a mean of 9.8 years after bracing is discontinued.

Adolescent↗
PubMed2000

Not all rods are Harrington - an overview of spinal instrumentation in scoliosis treatment.

BACKGROUND: Scoliosis is a multiplanar spinal deformity, which has been treated in the past with spinal fusion and cast application, starting in the early part of this century. In the last 30 years, Paul Harrington successfully introduced spinal instrumentation for scoliosis. Harrington instrumentation has had a large impact on the treatment of scoliosis. Currently, there are many different instrumentations available for the treatment of scoliosis. Indications differ for the use of these systems. Appreciation of spinal instrumentation is essential to treatment of the patient with scoliosis. Post-operative roentgenographic studies are better understood when the interface between instrumentation and the spine is understood. MATERIALS AND METHODS: Distinguishing characteristics between some of the more common instrumentations are noted. There continues to be a proliferation of spinal instrumentation systems. Roentgenograms and spinal models are used to explain how some of the instrumentation systems differ and how they interface with the spine. CONCLUSION: An overview of spinal instrumentation in scoliosis treatment will allow better understanding of the purposes of the hardware and how it relates to the spine.

Child↗
PubMed1998

Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis.

STUDY DESIGN: A retrospective clinical and radiographic review. OBJECTIVES: To provide current data on the results and complications of patients who have undergone spinal fusion for neuromuscular scoliosis at a center with physicians experienced in these types of cases. SUMMARY OF BACKGROUND DATA: The reported complication rate in the management of neuromuscular scoliosis ranges from 44% to 62% in the recent literature. This literature is that of 1991 or earlier reflecting operative techniques of the mid-1980s, and it has been used to argue against the efficacy of neuromuscular spinal fusions. METHODS: A retrospective chart and radiographic review of 50 consecutive spinal fusions for neuromuscular scoliosis was performed at Connecticut Children's Medical Center between January 1990 and January 1994. The three most common diagnoses were spastic quadriplegic cerebral palsy (20 patients), myelomeningocele (13 patients), and muscle disease (8 patients). There were 38 posterior spinal fusions including two kyphectomies and 12 anteroposterior spinal fusions. The Luque-Galveston technique was used in 39 of 50 patients. The average age at surgery was 13 years and 6 months, with an average follow-up of 40 months (minimum, 24 months). RESULTS: Before surgery, the mean major scoliosis measured 72 degrees, with mean best bend or traction view of 35 degrees. At most recent follow-up, the mean scoliosis magnitude was 25 degrees (mean correction, 65%). There were 17 minor complications in 14 patients and three major complications (deep wound infections) in three myelomeningocele patients. Rod breakage was noted in two patients, one of whom had an asymptomatic pseudarthrosis. There were no neurologic complications or deaths, and none of the complications affected the final results. CONCLUSIONS: The data in the current study support the authors' belief that with current surgical techniques and perioperative management in an experienced center, the results for patients undergoing spinal fusion for neuromuscular scoliosis have been improved, and major complications have been minimized.

Adolescent↗
PubMed1997

Outcomes research.

Explore the source record for details and available documents.

Child, Preschool↗
PubMed1993

Somatosensory evoked potential monitoring during Cotrel-Dubousset instrumentation. Report of a case.

Somatosensory evoked potentials produced by electrical stimulation of the posterior tibial nerve were recorded from surface electrodes at the scalp and cervical spine of a patient with scoliosis undergoing posterior spinal fusion with Cotrel-Dubousset instrumentation. During spinal derotation when hypotension and anemia were also present, the cortical and subcortical somatosensory evoked potentials disappeared. During a wake-up test, the patient demonstrated weakness of the left lower extremity, and derotation was stopped. The patient was given pharmacologic hypertensive agents and blood transfusions to increase blood pressure. Forty minutes later, somatosensory evoked potentials returned and a second wake-up test demonstrated normal function in both lower extremities. This report demonstrates the accuracy and usefulness of somatosensory evoked potential monitoring during spinal fusion with Cotrel-Dubousset instrumentation. To the authors knowledge, this is the first report demonstrating a correlation between abnormal SEP responses and intraoperative neurologic deficit during the derotation maneuver with Cotrel-Dubousset instrumentation and corrected by transfusion and restoration of normotension.

Adolescent↗
PubMed1993

Latex anaphylaxis during spinal surgery in children with myelomeningocele.

Intra-operative anaphylaxis to latex involves cutaneous, respiratory and circulatory changes which may prove fatal if not promptly recognized and treated. It is estimated that 18 to 40 per cent of children with spina bifida may be affected by latex allergy. Current tests available lack sufficient sensitivity and specificity to be recommended as routine screening measures, therefore any allergic history in children with myelomeningocele should alert the clinician to the possibility that severe anaphylactic reactions may occur, especially when large mucosal and pleural-peritoneal surfaces are exposed, as noted in the four reported cases. Epinephrine is the drug of choice should a Type 1 reaction occur.

Adolescent↗